At age 12, Ariadna Forray, MD, associate professor of psychiatry at Yale School of Medicine, had to leave her home country, Mexico, with her family. Her father, a researcher, had received a job offer.
She did not know English at the time, and struggled to learn the language.
Every summer up until college, she would go back to Mexico and spend the warm months with her aunts, uncles, and eight cousins. Less frequently, she would also visit her father’s family in Santiago, Chile.
She already knew she wanted to become a physician, and she had set her mind on obtaining a medical degree and going back to Mexico to work with underserved communities.
During her years as a medical student at Harvard Medical School and trainee at Yale, she had experiences that led her to do similar work but in a different place—the United States—where she also saw tremendous need.
A profound experience that influenced her was when she was doing a rotation in infectious diseases. “I ended up meeting this woman who was a single mom in her early 40s and had metastatic lung cancer,” Forray says. The woman spoke only Spanish and had a 17-year-old daughter.
Surgeons had removed a metastatic tumor from the woman’s brain, and Forray was monitoring the treatment of the infection at a surgical site. Forray recalls that despite being a never-smoker, the patient had a short time left to live.
“What I found was that I was fascinated with the idea of understanding her experience and talking to her about what it means to be going through this, what it means to be a single mom, and to know that she's leaving behind her daughter,” she says.
Language was a barrier to her patient. Forray adds, “And so [as a native Spanish speaker], I realized in that moment, how meaningful it was for me to be able to sit with someone while they're going through something really difficult and support them.”
A psychiatrist in training
The desire to learn about her patients’ life experiences was drawing Forray to psychiatry. Another experience in her residency was the one that made her want to specialize in her work with specific populations.
“I came across a patient who had suddenly had an acute sort of psychiatric decompensation and, by the time I met her, she was about eight weeks postpartum, and this was her third hospitalization. Previous to this [pregnancy], she had never had any history of any psychiatric issues, and no hospitalization,” Forray explains.
“So, to me, it was very curious how someone who seemingly never had any [mental health] issues before, suddenly after her second child, develops … what initially was thought to be postpartum depression, [but] ended up actually being postpartum psychosis.”
She started asking herself afterwards: What happens in pregnancy, in the postpartum period or in this transition that makes someone vulnerable to have something like this happen?
She pursued research in the role of neurosteroids in the brain and disease processing, which ultimately led her to explore substance-use disorders.
Forray has studied progesterone—a hormone that the body naturally produces—which is at its peak in a woman’s third trimester of pregnancy. She investigates how it can help pregnant or postpartum women to achieve substance abstinence, prevent relapse, and decreasi substance use.
“That’s how I got started in the area of what I call reproductive psychiatry,” she says.
The field now involves medications like zuranolone (Zurzuvae), which is a similar molecule to a metabolite of progesterone, and was recently approved by the Food and Drug Administration (FDA) for the treatment of postpartum depression.
The March of Dimes estimates that 15% of postpartum women develop postpartum depression.
Forray directs Yale’s Center for Wellbeing of Women and Mothers. She also is the Yale medical director of ACCESS Mental Health for Moms.
Being bicultural and bilingual
One of the biggest goals in psychiatry is creating connection with a patient. Unfortunately, that can be hard when a clinician and patient do not share the same cultural background and native language, since both influence perspective, Forray says. “A lot of it is connecting and communicating with the patient to really be able to get to the bottom of whatever the issue may be.”
“I remember very specifically when I was a resident, that I was really interested in being able to use the fact that I was bilingual and bicultural,” which are great advantages for clinicians who want to practice and promote cultural competence.
She wanted to work with the Hispanic patient population, so a specific rotation was set up for her during her training at Yale.
About bilingual and bicultural psychiatrists in the U.S., she says, “I do think that we really desperately need to be able to have more psychiatrists who have the cultural and language background and understanding that can really help improve the mental health of Latine patients.”
Working with sickle cell disease patients
Forray did not expect to work with patients living with sickle cell disease during her career until an opportunity presented itself to her as junior faculty member.
“I quickly fell in love with that patient population and the work that we were doing,” Forray says.
Patients who live with sickle cell disease usually are part of an underserved community.
In the United States, sickle cell disease predominantly affects African Americans as well as people from a Hispanic or Latino background. Many come from the Caribbean and are primarily Spanish speaking, which made Forray a great fit for the program.
Advice for aspiring diverse medical students
Although her goal was clear since her pre-teen years, Forray did not have an easy path to becoming a physician. She struggled with people who, in various ways, told her she was not good enough and should aspire to do other things because she is an immigrant.
Forray says she had to fight different assumptions and constantly prove she was capable.
As the co-director of YSM’s Minority Organization for Retention and Expansion (MORE), Forray says she is committed in recruiting a diverse residency class for her department as well as helping support and grow the faculty, the residents, and the students. She wants young physicians with backgrounds similar to hers to be able to progress with far fewer obstacles.
“I was usually one of a handful of minorities in whatever spaces I happened to be in. Having to navigate being ‘other’ in these spaces taught me the importance of finding and making community. That is what MORE has been for me, a place of belonging at Yale,” Forray says. “In my role as co-director, I want to be able to continue to provide that for other underrepresented faculty and trainees.”
To aspiring medical students from underrepresented groups, she has this advice: “If you have a dream, do not let anyone deter you from it. Seek people who are willing to help; they are out there, and you are not alone. Last, build a group of people who are willing to support each other.”
“We need people who have different perspectives,” she says, “because they're going to be the ones that are going to be able to do amazing things, and really give back a lot of times to the communities that really need it.”